KENYATTA NATIONAL HOSPITAL 1

PROMOTING RATIONAL USE OF ANTI-RETROVIRALS (ARV) AT KENYATTA NATIONAL HOSPITAL (KNH) IN KENYA BY OGILE ELIZABETH BPharm Pg Cert EDM & RDU MPSK

Authorized Establishment -6,212 In-post -5,225 KNH has a total of 9 pharmacies

INTRODUCTION AND PROBLEM STATEMENT HIV/AIDS has been viewed to affect productivity of workers and also to increase health treatment cost. KNH also faced a similar problem. ( Ref Kenya HIV/AIDS business Council Report ) . In Feb1998 the KNH management decided to avail free ARV treatment to staffs as non – scheduled/ Extraformulary drug. In June 1999, the situation was getting out of hand. There were no clear guidelines for prescribing and dispensing the ARVs. There were no proper records. Staff collected drugs from any pharmacy. The buying and supply of ARV was erratic. Further investigations revealed that ARV prescribing was from other sources, not specialists only. A number of prescriptions were not genuine. There was no monitoring and follow up on the genuine patients. Frequent stock out periods.

The hospital management mandated the Medical Advisory Committee ( MAC) to review the situation and then make recommendations.

OVERALL GOAL MAC came up with the following policy interventions to be implemented at prescribing and pharmacy levels.

SETTING AND POPULATION Kenyatta National Hospital. Prevalence of infection 10% (520) Staffs diagnosed to be HIV/AIDS positive and presented with prescriptions in the pharmacy ( about 100 patients )

INTERVENTIONS ( MARCH 2000 ) MAC recommendations were implemented at prescribing and dispensing level. PRESCRIBING Limiting prescribing to only 3 appropriately trained clinical specialists and ensuring that each patient had a specific file opened. The staffs had to take their prescriptions for countersigning by Head of clinical services for verification.

INTERVENTION….CONTD DISPENSING Dispensing was centralized to one pharmacy. The dispensers ensured that prescriptions were countersigned and also had the recommended combinations. Patients were required to purchase an item out of stock and bring to the pharmacy to receive available drugs ( Provision for reimbursement ). Computerized record keeping system was introduced in the pharmacy. ARV monitoring form was introduced in march 2001.

RESULTS Preliminary results show that 16% of the ARV prescriptions as at June 1999 were not genuine ( not real patients ). The situation as at March 2001 show that there was still about 2% of ungenuine prescriptions. We have created a database for monitoring ARV therapy and for controls.

KENYATTA NATIONAL HOSPITAL ARV THERAPY MONITORING FORM Personal Details Patient Number: Patient Name: Gender: Address: Age: Tel: Weight: E-mail: BSA: Clinical Parameters CD4 count Viral Load Date

Antiretroviral Therapy Reg. No. Combination Start Date Stop Duration Reason for stopping Compliance Toxicity

Dispensing Drug Quantity Pharmacist Date Collected Next Supply

LESSON LEARNT It is difficult to manage ARV treatment of staffs by staffs. Simple policy interventions can be used effectively to promote Rational ARVS usage. BUT …….. The patients were getting tired ( complaining ).

CONCLUSION Comprehensive care unit was set in October 2002 Comprehensive care unit ( CCU ) borrowed the concepts of the policy interventions. In April 2003 the staffs HIV/AIDS management programme was intergrated into CCU program.

- KNH management and staffs Chief pharmacist Dr. G Ombuya THANK YOU ACKNOWLEDGEMENTS - KNH management and staffs Chief pharmacist Dr. G Ombuya - Dr. Atieno Ojoo Gertrudes Garden Childrens' Hospital Mr. Mwangi Maina